Review: depression is associated with an increased risk of developing stroke

only men and one only enrolled women. Ten studies were conducted in the USA, six in European countries and one in Japan. The main factors adjusted for in the studies were age, gender, body mass index, smoking, education, hypertension, diabetes and history of cardiac disease. A positive association between depression and stroke was found in 14 studies, this association reached statistical signifi cance in eight studies. In the meta-analysis, participants with depression had a signifi cantly increased risk of developing stroke compared with those without depression (17 studies; RR 1.34, 95% CI 1.17 to 1.54). However, signifi cant heterogeneity was observed among the studies (I 2 =55.1%, p=0.003). The positive association between depression and stroke was shown for both men and women (men: eight studies, RR 1.49, 95% CI 1.28 to 1.74; women: seven studies, RR 1.35, 95% CI 1.05 to 1.72). The analysis in men did not show heterogeneity (p=0.24; I 2 =23.4%). When studies with less than 5 years of follow-up were excluded, the association between depression and stroke remained signifi cant (15 studies; RR 1.33, 95% CI 1.16 to 1.53). In addition, when analysis was restricted to studies that used the Center for Epidemiological Studies Depression scale for assessment of depression, depression remained signifi cantly associated with an increased risk of stroke, with no evidence of heterogeneity (eight studies; RR 1.23, 95% CI 1.13 to 1.34; I 2 =0%, p for heterogeneity=0.86). CONCLUSIONS Depression is associated with a signifi cantly increased risk of developing stroke. This association may be independent of other risk factors such as high blood pressure and diabetes.